Print this document  out and use to keep track of your Asthma symptoms. Don't forget to bring with you when you visit the doctor.


You can follow your asthma progress by watching your symptoms, your need for reliever medicine and your peak expiratory flow (PEF) results.


The following diary will help you watch your asthma symptoms. If you use a peak flow meter, also use the peak expiratory flow graph in ‘Peak Expiratory Flow PEF Monitoring’

Record the number of times each day you have: My Target Goals* Date Date Date Date
Daytime Symptoms

(cough, chest tightness, shortness of breath)

Night-time Symptoms
Asthma Attacks

Did you limit your physical activity

today because of your asthma? Y=yes N=no

How many puffs of reliever medicine did you use today?

How many puffs of other medicine(s)

did you use today?

* Set these goals in conjunction with your doctor.

Request a Refill

10 + 5 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.